Get the free OSHA Respirator Medical Evaluation Questionnaire

This document is a medical evaluation questionnaire for employees selected to use respirators, aiming to assess their ability to safely wear respiratory protective equipment and ensure their health

How to fill out osha respirator medical evaluation

How to fill out OSHA Respirator Medical Evaluation Questionnaire

1. Begin with your personal information: Enter your name, job title, and department.
2. Provide your age, gender, height, and weight for demographic purposes.
3. Answer the health history questions honestly: This includes information about any respiratory conditions, allergies, or other medical issues.
4. Indicate your smoking history: Specify if you currently smoke, used to smoke, or have never smoked.
5. Review any medications you are currently taking and list them if necessary.
6. Respond to questions about your work-related exposure to hazardous substances and environments.
7. Fill out information regarding your respiratory protection needs: Specify the type of respirator you plan to use.
8. Sign and date the questionnaire to certify that the information provided is accurate.

Who needs OSHA Respirator Medical Evaluation Questionnaire?

1. Anyone who is required to wear a respirator as part of their job needs to fill out the OSHA Respirator Medical Evaluation Questionnaire.
2. This includes workers in industries like construction, healthcare, chemical manufacturing, and other fields where airborne contaminants are present.

People Also Ask about

What is involved in the medical evaluation and fit test for a respirator?

A physician or other licensed health care provider (PLHCP) reviews the questionnaire responses to determine if the employee has any symptoms or conditions that could undermine the effectiveness of a respirator. A follow-up medical exam and testing may also be performed before rendering a final decision.

What is the OSHA respirator medical evaluation questionnaire?

This easy-to-use OSHA respirator medical evaluation questionnaire helps establish the worker's clearance level for using a specific respirator in your work conditions. It can be completed in 15-20 minutes using any computer with internet access, and is available every day, any time, to fit your employees' schedules.

What are OSHA's two checks for wearing a respirator?

Qualitative fit test (QLFT) means a pass/fail fit test to assess the adequacy of respirator fit that relies on the individual's response to the test agent. Quantitative fit test (QNFT) means an assessment of the adequacy of respirator fit by numerically measuring the amount of leakage into the respirator.

What is the OSHA respirator clearance?

Respirator Clearance (OSHA 1910.134) From a medical standpoint, all respirator-wearing personnel shall have a medical evaluation, provided by the department, to determine the employee's ability to use a respirator. This medical evaluation should occur prior to the employee being allowed to wear a respirator.

What is the OSHA test for respirators?

Fit Testing The Occupational Safety and Health Administration (OSHA) (29 CFR 1910.134) requires an annual respirator fit test to confirm the fit of any respirator that forms a tight seal on the wearer's face before it is used in the workplace.

What is required before using a respirator ing to OSHA?

All employees using anegative or positive pressure tight-fitting facepiecerespirator must pass an appropriatequalitative fit test (QLFT)orquantitative fit test (QNFT). Fit testing is required prior to initial use, whenever a different respirator facepiece is used, andat least annually thereafter.

How often does OSHA require fit testing for respirators?

Under 1910.134, fit testing must be performed initially (before the employee is required to wear the respirator in the workplace) and must be repeated at least annually.

For pdfFiller’s FAQs

What is OSHA Respirator Medical Evaluation Questionnaire?

The OSHA Respirator Medical Evaluation Questionnaire is a form used to assess an individual's medical fitness to wear a respirator. It helps employers determine if employees can safely use respirators in the workplace.

Who is required to file OSHA Respirator Medical Evaluation Questionnaire?

All employees who are required to use respirators in the workplace must complete the OSHA Respirator Medical Evaluation Questionnaire to ensure they are medically able to wear the equipment safely.

How to fill out OSHA Respirator Medical Evaluation Questionnaire?

To fill out the questionnaire, employees should carefully read each question and answer truthfully about their medical history, current health status, and any specific conditions that might affect their ability to use a respirator.

What is the purpose of OSHA Respirator Medical Evaluation Questionnaire?

The purpose of the OSHA Respirator Medical Evaluation Questionnaire is to identify any medical conditions that could pose a risk when wearing a respirator, thereby ensuring the safety and health of employees during respirator use.

What information must be reported on OSHA Respirator Medical Evaluation Questionnaire?

The questionnaire requires information regarding an employee’s medical history, current medications, history of respiratory diseases, cardiovascular conditions, and other relevant health issues that could affect respirator use.